Publications by Year: 2020

2020
Slavin SD, Allen LA, McIlvennan CK, Desai AS, Schaefer KG, Warraich HJ. Left Ventricular Assist Device Withdrawal: Ethical, Psychological, and Logistical Challenges. J Palliat Med. 2020.
Slavin SD, Warraich HJ. The right time for palliative care in heart failure: a review of critical moments for palliative care intervention. Rev Esp Cardiol (Engl Ed). 2020;73 :78-83.Abstract
Heart failure (HF) is a progressive condition with high mortality and heavy symptom burden. Despite guideline recommendations, cardiologists refer to palliative care at rates much lower than other specialties and very late in the course of the disease, often in the final 3 days of life. One reason for delayed referral is that prognostication is challenging in patients with HF, making it unclear when and how the limited resources of specialist palliative care will be most beneficial. It might be more prudent to consider palliative care referrals at critical moments in the trajectory of patients with HF. These include: a) the development of poor prognostic signs in the outpatient setting; b) hospitalization or intensive care unit admission, and c) at the time of evaluation for certain procedures, such as left ventricular assist device placement and ablation for refractory ventricular arrhythmias, among others. In this review, we also summarize the results of clinical trials evaluating palliative interventions in these settings.